From vt

ABSTRACT

METHODS OF MONITORING AND ANALYZING ELECTROCARDIOGRAPHIC SIGNAL DATA, TO IDENTIFY ARRHYTHMIAS AND THE LIKE, REQUIRE SELECTION OF REAL QRS COMPLEXES AND REJECTION OF ARTIFACTS THAT LOOK LIKE REAL QRS COMPLEXES. TO ACHIEVE THIS END, TWO TABLES OF QRS COMPLEX SHAPES ARE EMPLOYED IN A DIGITAL COMPUTER, WITH THE FIRST TABLE CONTAINING THE SHAPES OF DIFFERENT VERSIONS OF REAL QRS COMPLEXES AND THE SECOND TABLE CONTAINING THE SHAPES OF QRS-TYPE COMPLEXES WHICH HAVE NOT YET BEEN DETERMINED REAL BUT ARE CANDIDATES FOR BEING CONSIDERED REAL. AS SHOWN IN FIG. 3, A LOCATED QRS-TYPE COMPLEX IS FIRST COMPARED TO THE VARIOUS SHAPES ON THE &#34;REAL SHAPES&#34; TABLE, AS REPRESENTED BY THE STEPS OF BLOCKS 33 AND 35. IF IT COMPARES WITH NONE, IT IS THEN COMPARED TO THE SHAPES ON THE &#34;CANDIDATE   SHAPES&#34; TABLE, AS REPRESENTED BY THE STEPS OF BLOCKS 3341. IF IT COMPARES WITH NONE OF THE SHAPES ON THE &#34;CANDIDATE SHAPES&#34; TABLE, IT IS ADDED THERETO AS A NEW CANDIDATE, AS SHOWN AT STEP 43. IF IT COMPARES WITH ONE OF THE SHAPES ON THE &#34;CANDIDATE SHAPES&#34; TABLE, THAT FACT IS NOTED AT STEP 45 AND MORE CREDENCE IS GIVEN THAT SHAPE AS BEING A POSSIBLE NEW VERSION OF A REAL QRS COMPLEX. MEASUREMENTS ARE ALSO MADE AT STEP 45 FOR EVALUATING CANDIDATE SHAPES AND DECISION LOGIC IS EMPLOYED AT STEP 49 TO ULTIMATELY DECIDE WHETHER OR NOT A CANDIDATE SHAPE, AFTER HAVING BEEN SEEN SEVERAL TIMES, IS A NEW VERSION OF A REAL QRS COMPLEX.

DEFENSIVE PUBLICATION UNITED STATES PATENT OFFICE Published at the request of the applicant or owner in accordance with the Notice of Dec. 16, 1969, 869 0.G. 687. The abstracts of Defensive Publication applications are identified by distinctly numbered series and are arranged chronologically. The heading of each abstract indicates the number of pages of specification, including claims and sheets of drawings contained in the application as originally filed. The files of these applications are available to the public for inspection and reproduction may be purchased for 30 cents a sheet.

Defensive Publication applications have not been examined as to the merits of alleged invention. The Patent Oflice makes no assertion as to the novelty of the disclosed subject matter.

PUBLISHED AUGUST 6, 1974 T925,003 ECG MONITORING METHOD Raymond E. Bonner, Yorktown Heights, N.Y., assignor to International Business Machines Corporation, Armonk, N.Y.

Continuation of application Ser. No. 51,236, July 30, 1970. This application June 29, 1973, Ser. No. 375,284 Int. Cl. A61b 5/04 US. Cl. 444-1 6 Sheets Drawing. 32 Pages Specification Methods of monitoring and analyzing electrocardiographic signal data, to identify arrhythmias and the like, require selection of real QRS complexes and rejection of artifacts that look like real QRS complexes. To achieve this end, two tables of QRS complex shapes are employed in a digital computer, with the first table containing the shapes of different versions of real QRS complexes and the second table containing the shapes of QRS-type complcxes which have not yet been determined real but are candidates for being considered real. As shown in FIG. 3, a located QRS-type complex is first compared to the various shapes on the real shapes table, as represented by the steps of blocks 33 and 35. If it compares With none, it is then compared to the shapes on the candidate CRMPARE TD DRS SHAPES ALREADY DH REAL SHAPES TABLE 35 DR CANDIDATE SHAPES TABLE DOES IT HATCH Alli REAL SHAPES? GAlHER STATISTICS 37 ms IT men in on nus; sums CANDIDATE SHAPES? no YES PUT AS NEW m2 mums:

ENTRY MEASUREMENTS AND 4 CANDIDATE UPDATE EVALUATION sums TABLE PAR nssu on EVALUATION PARAMETERS,DECIDE REMOVE FRO f 0" WHETHER SHAPE l5 ARTIFADT CANDIDATE 0R REAL SHAPE TABLE EXIT F shapes table, as represented by the steps of blocks 33- 41. If it compares with none of the shapes on the candidate shapes table, it is added thereto as a new candidate, as shown at step 43. If it compares with one of the shapes on the candidate shapes table, that fact is noted at step 45 and more credence is given that shape as being a possible new version of a real QRS complex. Measurements are also made at step 45 for evaluating candidate shapes and decision logic is employed at step 49 to ultimately decide whether or not a candidate shape, after having been seen several times, is a new version of a real QRS complex.

Aug- 6, 1 74 R. E. BONNER EGG MONITORING METHOD 6 Sheets-Sheet 1.

Original Fild July 30, 1970 FDnFDO INVENTOR RAYMOND E. BONNER SZEOOKQ Aug. 6,1974

Original Filed July 30, 1970 R. a. BONNER EGG MONITORING METHOD ENTRY 6 Sheets-Sheet 2 mm QRS-TYPE COMPLEX 3i COMPARE To oBs SHAPES ALREADY 0N REAL SHAPES TABLE f 35 OR CANDIDATE SHAPES TABLE DOES IT MATCH ANY REAL SHAPES 2 55 YES NO GATHER STATISTICS 57 DOES IT NATcN ANY 41 ON THESE SHAPES CANDIDATE SHAPES 2 N NO YES I T P fig NANE REQUIRED MEASUREMENTS AND 45 5 CANDIDATE UPDATE EVALUATION SHAPES TABLE PARAMETERS HAVE 5 SUCH SHAPES 47 BEEN sEEN YET A 1 NO YES BAsEB 0N EVALUATION L l N PARAMETERS, DECIDE 49 REMOVE FROM PUT ON WHETHER SHAPE IS ARTIFACT CANDI B-ATE REAL SHAPE 0R REAL SHAPE TABLE BL 53 55 IS IT ARTIFACT 51 YES No Aug. 6,1974

Original Filed July 30,

R. E. BONNER EGG MONITORING METHOD 6 Sheets-Sheet 3 FIG, ENTRY 4A FIG. 4A

FIG.

43 IS THIS COMPLEX "CLOSE" TO THE PRECEDING COMPLEX r61 FIG (WHERE THE T wAvE NORMALLY IS)? YES NO ADD 2 T0 AT WAS THE R-R INTERVAL ROUGHLY coNsTAN IN THE LAST BUFFER? YES NO A IS THE INTERVAL FROM THIS COMPLEX To THE LAST WITHIN TooNsoE THIS R-R INTERVAL /65 I IS IT LESS THAN THTs RR (COMPLEX OCCURRING AT NORMAL TIME)? INTERVAL (PREMATURE) N0 YES o YES sNRTRAcT2ER0N AT F67 SUBTRACTZFROM NT 15 THE TIME FROM THE PRECEDING 71A COMPLEX T0 THE FOLLOWING COMPLEX WITHIN 200 Rs 0F TWICE THIS R-R INTERVAL-(COMPENSATORY PAUSE)? YEs Nov ADD 2 T0 NT 75 IS THIS TIME WITHIN T00 Ns OF THIS SUBTRACT 5 FROM AT R-R TNTERNALHNTERPNLATEN)? NO YES ADDSTO AT Aug. 6, 1914 6 Sheets-Shet 4 FIG. 48 ARE THE PMEASUREMENTS DEFINED? TEs NO I I5 THE NORMALP WAVE 0F 82/JSTHERE APWAVE IN FRONT AMPLITUDE LARGER THAN OF THE NEW COMPLEX? .9 TENTHS OFA MILLIVOLT? NO YES NO I YES QON IS THERE APON THE PRECEDINGT WAVE? 86 E N SUBTRACT 2 SUBTRACT 5 FROM vT FROM VT suDTRAc'T2 84 FROM vT f Ts TRE NORMAL PWAVE 0F AMPLITUDE LARGER THAN .9 TENTHS OF A MILLIVOLT? YES NO ADD 2 ADDT To vT TM g- 6, 1974 R. E. BONNER I 'T925,003

EGG MONITOR IHG METHOD Original Filed July so, 1970 e Sheets- Sheet 5 ADD THE VALUESA AND V FOR THE CANDIDATE SHAPE TO AT AND VT RESPECTIVELY IS THIS CANDIDATE SHAPE "GRDSSLY 5 DIFFERENT" FROM THE NDRMAL QRS? ND YES ADD 2 T0 VT DOES THE TwAvE AMPLITUDE DOES THE T WAVE AHRLITuITE OF THE NEW COMPLEX DIFFER OF THE NEW COMPLEX DIFFER 85\ FROM THE NORMAL T W BY FROM THE NORMAL T wAvE BY MORE THAN 2TENTHS OFA HILLIvIILT? I HoR THAN 2TEIITHs OFA MILLIVOLT? N0 YES A YES N0 RTN SUBTRACT2 IsTHETwAvEoF THE IS THETwAvE OF THE SUBTRACTI I01 FROM VT A NEW COMPLEX LARGER THAII NEW COMPLEX LARGER THAN FROM VT L5 TEIITHs OF A MILLIVOLT? Is TEHTHs OFA MILLIVOLT? N0 A YES YES NO Is THIS T MORE THAN W I 4TENTHSOFA MILLIVOLT. 95 QP E DIFFERENT FROM NORMAL? IIEs HoI I EXIT I g- 1974 R. E. BONNER sec uom'ronms METHOD S Original Filed July 30, 1970 ENTRY YES NO 6 Sheets-Sheet 6 IS VT 20 129 NO YES HAS THE TOTAL TIME To ACCUMULATE THE FIVE COMPLEXES BEEN LESS T W THAN 41 SECONDS OR MORE L "1 THAN 360 SECONDS T 155 YES NO lSVT H5 v YES NO v |SVT VPC I E NO YES I V AR FACT VPC CANT DECIDE BETWEEN NORMAL z AND VPC;

T T25 REMOVE FROM LIST OFCANDHJATE SHAPES HOPING IT WILL REAPPEAR E To BE REVALUATED HAS THE TIME To ACCUMULATE 1 HS/ THE. FIVE COMPLEXES BEEN OVER 28? SECONDS NO I YES NORMAL ORS l\ M 

